Denial of Accidental Death Benefits Based in Sickness Exclusion

Our clients in this case were the beneficiaries on the accidental death policy of their brother, who tragically died when the motorcycle he was riding crashed into a car in front of him. The AD&D policy was issued by Standard. After our clients filed a claim, Standard conducted an independent investigation and medical review of the toxicology report, coroner’s report and autopsy report. Standard denied the claim based on the sickness exclusion. The exclusion reads, “No AD&D Insurance benefit is payable if the accident or Loss is caused or contributed to by any of the following: 1) Sickness or Pregnancy existing at the time of the accident.” In its review process Standard hired a medical consult to draft an opinion as to whether the insured had a sickness that could have contributed to his death. The medical consultant concluded that the insured’s hypoglycemia may have contributed to or caused the accident. Standard relied on this opinion and denied the claim. Our clients turned to us for help after their many attempts to persuade the insurer that their brother controlled his diabetes failed. When attorney Tatiana Kadetskaya studied the case, she noticed that the insurance company lacked sufficient evidence to conclusively determine that the insured’s hypoglycemia contributed to or caused the accident. After thorough investigation and research, she prepared and filed an appeal. Standard reviewed the appeal for 60 days and reversed the denial. Our clients were happy to receive their AD&D benefits fast.

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